Jonathan Heller

Are our (lack of) labor laws making you sick? Paid sick days & public health

Over 5 million workers in California – almost 40% of the workforce – do not have paid sick days. That includes 70% of restaurant workers, 25% of nursing home workers, 40% of mothers of kids with asthma, and 79% of the lowest paid workers in the state. Most people probably think of paid sick days (PSD) as one element of a comprehensive labor policy. But what are its implications for public health? Human Impact Partners conducted a health impact assessment to find out, and were surprised by the huge public health impacts. We were also surprised by the disconnect between known best practices to prevent disease and current sick day laws and practices.

My organization – Human Impact Partners, a California-based organization that evaluates health impacts and inequities to improve policy – and researchers at the San Francisco Department of Public Health just completed a study of proposed legislation (California State Assembly Bill AB 2716, introduced by Assemblymember Fiona Ma) that would guarantee all workers in California at least one hour of paid sick time for every 30 hours worked. The State Assembly passed the legislation – titled the Healthy Families, Healthy Workplaces Act of 2008 – but it died last week in the Senate Appropriations Committee.

Using data from existing public health literature and statistics, survey data, and focus groups, we found that AB 2716 – guaranteeing paid sick days for workers in California – would have significant positive public health benefits for all Californians. We showed that guaranteed paid sick days for all workers would:

1) help reduce the spread of flu;
2) protect the public from diseases carried by sick workers in restaurants and in nursing homes;
3) enable workers to stay home to care for a sick dependent; and
4) prevent hunger and homelessness among low-income workers with severe illnesses.

The 5.4 million workers without paid sick days include 70% of restaurant workers. Yet, more than half of food-related disease outbreaks occur in restaurants. The Centers for Disease Control and Prevention documented that a single restaurant worker who did not have PSD and came to work sick infected 500 people with stomach flu in Michigan in 2006. And the CDC has documented other similar cases as well: this is not atypical. To prevent such outbreaks, the California Retail Food code allows restaurant workers to be excluded from work when they have stomach flu.

But, not having PSD is a barrier to following such rules- there is a disconnect. Restaurant workers who are sick now have to choose between either staying home (leave without pay) or getting paid (which would enable them to pay the rent or buy food) and, at the same time, infecting customers and co-workers.

The 5.4 million workers also include 25% of nursing home workers. Studies show that there would be at least 30 fewer stomach flu outbreaks each year among the elderly in nursing homes if paid sick days were guaranteed by law.

And the 5.4 million workers include others who need PSD most, such as parents of kids with chronic diseases like asthma and most low-paid workers, such as those in retail and other jobs that involve frequent contact with the public. For low-wage workers, the economic impacts of staying home when sick are severe and also have real health consequences.

In addition to all this, guaranteed paid sick days would reduce flu outbreaks. One third of flu cases are transmitted in schools and workplaces. PSD would greatly reduce the number of people infected by new flu strains and so help to contain a pandemic. That’s why the CDC recommends that people stay home from work and school when sick. Paid sick days would allow people to follow that recommendation. But currently there is a disconnect between the recommendation and what is actually encouraged by policy.

Our research suggests that this legislation would be a commonsense policy that would protect the health of all Californians. It is important for policymakers to see paid sick days not only as a labor policy, but also as a sensible and effective public health policy. And it is important for policymakers to fix the disconnect between commonsense best health practices and the laws and systems to support paid sick days.

I want to note that the kind of analysis we conducted – a health impact assessment – is relatively new in the United States, but has been an effective tool in improving health in other countries. Although there is a lot of existing data connecting working conditions to health, it is still not very common in the United States to look at proposed legislation through a health lens. As this analysis demonstrates, the health lens provides a valuable perspective. It is the mission of Human Impact Partners to bring health into the discussion in all decision making.

So, why did the bill die in California’s Senate Appropriations Committee? In theory, this law would only affect employers. Although most state employees already have paid sick days, it would cost the State too much in this year of fiscal crisis to provide paid sick days to the large number of state-contracted healthcare workers who do not currently have the benefit. We’d rather send our healthcare workers to work sick (so they can get their patients sick) than pay for them to be able to stay home when they themselves are sick.

The Chamber of Commerce labeled this bill as a “job killer”. Three things to note about that. First, they can’t be suggesting that killing jobs is worse than killing people! Second, 9 out of the 10 most competitive countries, as judged by the World Economic Forum give their workers paid sick days. The United States is the only one in the top 10 that does not. Third, a cost-benefit analysis done by Vicky Lovell at the Institute for Women’s Policy Research shows a large net economic benefit for the proposed law.

We plan to work with the sponsoring coalition again next year when they re-introduce the bill. And we plan on working with groups in other states and those working on a federal bill, too.

So, next time you’re eating out, visiting a parent in a nursing home, getting healthcare, or when your kid is sick, think about paid sick days and how the policy (or lack thereof) affects you and your family and friends.

Last May, the Drum Major Institute held a Marketplace of Ideas event at which Sara Flocks of Young Workers United discussed San Francisco's paid sick day law. U.S. Representative Carolyn Maloney, New York City Councilmember Gale Brewer, and David Jones of the Community Service Coalition of New York also participated.

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